中心靜脈置管是現代重癥醫學救治危重患者的常用方法, 目前應用十分廣泛。盡管這些導管提供了必要的血管通路, 但也將患者置于局部和全身性感染并發癥的危險之中, 增加了感染的發生率, 并使導管相關性血流感染( catheter-related bloodstream infections, CRBSI) 更為常見, 明顯延長了ICU 住院時間并增加了醫療費用。本文就近年來CRBSI 的發病機制、微生物學、診斷及治療, 尤其是如何根據病原體對CRBSI 進行治療做一概述。
Objective To investigate the clinical characteristics and bacterial drug resistance of bloodstream infection of gram-negative bacteria, and provide guidance for clinical rational drug use and control of hospital infection. Methods A retrospective analysis was conducted in the patients diagnosed as severe pneumonia with blood culture of gram-negative bacteria from January 2015 to December 2017 in Beijing Anzhen Hospital. Results A total of 60 severe pneumonia patients suffered from bloodstream infection of gram-negative bacteria were recruited including 34 males and 26 females aging from 42 to 89 years and 73.4 years in average. In the 60 patients, 32 cases were infected with Klebsiella pneumonias, 20 cases were infected with Acinetobacter baumanni, and 8 cases were infected with Escherichia coli. The antimicrobial susceptibility testing result of Klebsiella pneumonias showed that the drug susceptibility rate was 100% to tigecycline, and 6.3% to amikacin. Escherichia coli was sensitive to Amikacin, imipenem, ceftazidime and meropenem while resistance to other drugs. The antimicrobial resistance of Acinetobacter baumanni was 28.6% for cefoperazone/sulbactam, and 14.3% for tigecycline. C-reactive protein, procalcitonin and SOFA scores were higher in the patients infected with Acinetobacter baumanni. Neutrophils and blood lactic acid were higher in the patients infected with Klebsiella pneumonias. There were no statistical differences in white blood cell, platelet or motality rate between the patients infected with Acinetobacter baumanni and the patients infected with Klebsiella pneumonias. SOFA scores and blood lactic acid had significantly statistical relevance with prognosis. Conclusion There is a high proportion of drug resistance of Klebsiella pneumoniae and Acinetobacter baumanni in the bloodstream infection of gram-negative bacteria.
Objective To investigate the predictors for carbapenem-resistant Acinetobacter baumannii, Enterobacteriaceae and Pseudomonas aeruginosa (CR-AEP) as the pathogens of bloodstream infection (BSI) for intensive care unit (ICU) patients. Methods A retrospective case-control study based on ICU- healthcare-associated infection (HAI) research database was carried out. The patients who have been admitted to the central ICU between 2015 and 2019 in the ICU-HAI research database of West China Hospital of Sichuan University were selected. The included patients were divided into two groups, of which the patients with ICU-acquired BSI due to CR-AEP were the case group and the patients with BSI due to the pathogens other than CR-AEP were the control group. The clinical features of the two groups of patients were compared. Logistic regression model was used to identify the predictors of BSI due to CR-AEP.ResultsA total of 197 patients with BSI were included, including 83 cases in the case group and 114 cases in the control group. A total of 214 strains of pathogenic bacteria were isolated from the 197 BSI cases, including 86 CR-AEP strains. The results of multivariate logistic regression analysis showed that previous use of tigecycline [odds ratio (OR)=2.490, 95% confidence interval (CI) (1.141, 5.436), P=0.022] was associated with higher possibility for CR-AEP as the pathogens of BSI in ICU patients with BSI, while previous use of antipseudomonal penicillin [OR=0.497, 95%CI (0.256, 0.964), P=0.039] was associated with lower possibility for that. Conclusion Previous use of tigecycline or antipseudomonal penicillin is the predictor for CR-AEP as the pathogens of BSI in ICU patients with BSI.
ObjectiveTo analyze the clinical characteristics, risk factors, and drug resistance of pathogenic bacteria in patients with blood stream infections (BSI) after orthopedic surgery, so as to provide reference and basis for clinical diagnosis and treatment.MethodsA retrospective analysis was made on the clinical data of 6 348 orthopedic patients admitted for surgery between January 2017 and December 2019. There were 3 598 males and 2 750 females. Their age ranged from 18 to 98 years, with an average of 66 years. The data of patients were collected, and the risk factors of BSI were analyzed by univariate analysis and logistic regression analysis. The distribution of BSI pathogenic bacteria, the results of drug sensitivity test, the incidence of BSI in patients after orthopedic surgery in different years, and the common sites of BSI secondary infection were summarized.ResultsBSI occurred in 106 (1.67%) of 6 348 patients after orthopedic surgery. There were 71 cases (66.98%) of secondary infection. The mortality of postoperative BSI patients was 1.89%, and the difference was significant when compared with that of non-postoperative BSI patients (0.24%) (χ2=5.313, P=0.021). The incidences of BSI in 2017, 2018, and 2019 were 1.18%, 1.53%, and 2.17%, respectively, showing an increasing trend year by year (trend χ2=6.610, P=0.037). Statistical analysis showed that the independent risk factors for BSI after orthopedic surgery (P<0.05) included the trauma, length of hospital stay≥14 days, emergency surgery, postoperative leukocyte counting<4×109/L, level of hemoglobin≤90 g/L, albumin≤30 g/L, the time of indwelling ureter>24 hours, use of deep vein catheter insertion, and merging other site infection. Blood culture showed 56 strains (52.83%) of Gram-positive bacteria, 47 strains (44.34%) of Gram-negative bacteria, and 3 strains (2.83%) of fungi. The top three pathogenic bacteria were coagulase negative Staphylococci (CNS; 36 strains, 33.96%), Escherichia coli (16 strains, 15.09%), and Staphylococcus aureus (15 strains, 14.15%). The detection rates of extended-spectum β-lactamases producing strains of Escherichia coli and Klebsiella pneumoniae were 56.25% (9/16) and 44.44% (4/9), respectively. The detection rates of methicillin-resistant strains in Staphylococcus aureus and CNS were 46.67% (7/15) and 72.22% (26/36), respectively.ConclusionPostoperative BSI in orthopedic patients is caused by multiple factors. Preventive measures should be taken according to related risk factors and perioperative risk assessment should be strengthened. Staphylococcus and Escherichia coli are the most common pathogenic bacteria in BSI after orthopedic surgery. The infection rate and drug-resistant bacteria are increasing year by year. Therefore, drug resistance monitoring should be strengthened.
Objective To explore the vascular access infection (VAI) incidence of hemodialysis patients during the the maximum spread of the COVID-19 epidemic (epidemic period) compared with the corresponding period with no local cases of COVID-19 (control period). Methods A single-center, retrospective study was carried out. Adult patients who underwent hemodialysis at the Department of Blood Purification Center, the Affiliated Hospital of Xuzhou Medical University during the epidemic period between December 7, 2022 and February 23, 2023 and the control period between December 7, 2020 and February 23, 2021 were selected. The incidence of local access site infection (LASI) and access related bloodstream infection (ARBSI) in included patients were observed and compared. ResultsA total of 1 401 patients were included. Among them, there were 737 cases during the epidemic period and 664 cases during the control period. There was no statistically significant difference in the age, gender, and duration of catheterization among patients of different periods and pathway types (P>0.05). There was no statistically significant difference in the occurrence of LASI between the epidemic period and the control period (χ2=1.800, P=1.180). There was a statistically significant difference in the occurrence of ARBSI between the epidemic period and the control period [χ2=4.610, relative risk (RR)=2.575, 95% confidence interval (CI) (1.053, 6.298), P=0.032]. There was no statistically significant difference in the incidence of LASI and ARBSI at different stages in patients with arteriovenous fistula and unnel-cuffed catheters (TCC) (P＞0.05). There were statistically significant differences in the incidence of LASI [χ2=4.898, RR=3.832, 95%CI (1.058, 13.885), P=0.027] and ARBSI [χ2=7.150, RR=4.684, 95%CI (1.333, 16.460), P=0.005] among non cuffed catheters (NCC) patients at different stages. TCC patients might experience LASI (P<0.05) during the epidemic period and ARBSI (P<0.05) during the control period compared with the arteriovenous fistula patients; both central venous catheterization and NCC patients might experience LASI and ARBSI during the control period (P<0.05). Conclusion Targeting COVID-19 prevention may be associated with the reduction of vascular access infection in hemodialysis patients, in particular in NCC patients.
Objective To analyze distribution and drug resistance of pathogens in bloodstream infection in Sichuan Antibiotic Resistance Monitoring Network in 2016, and to provide the basis for clinical rational use of antimicrobial drugs in Sichuan province. Methods A total of 14 543 strains of bacteria in bloodstream infection were collected from Sichuan Antibiotic Resistance Monitoring Network in 2016. Bacteria strains were identified to species, drug susceptibility test was performed by using the MIC and disc diffusion method (KB method). The results were interpreted according to the clinical laboratory standards institute CLSI 2016. Drug resistance was analyzed by using WHONET 5.6 software. Results Among the 14 543 strains of bacteria, Escherichia coli (34.5%), Klebsiella pneumoniae (10.7%), Staphylococcus epidermidis (10.2%), Staphylococcus aureus (7.2%), Staphylococcus hominis (6.0%) ranked the first five. Resistance rate to imipenem was 0.9% for Escherichia coli, resistance rate to imipenem was 2.4% for Klebsiella pneumoniae. No vancomycin-resistance and linezolid-resistance Staphylococcus epidermidis, Staphylococcus aureus and Staphylococcus hominis were found. MRSA detection rate was 25.8%. Conclusion Gram negative bacteria are the main pathogens in the blood cultures in Sichuan province, while attention should pay to the Staphylococcus.
Objective To investigate the characteristics of the pathogens causing bloodstream infection after general surgery in infant and young children patients, and to provide the references for disease treatment and nosocomial infection control. Methods The clinical and laboratory examination data after general surgery in infant and young children patients, who were admitted to our hospital from January 2012 to March 2017, were retrospectively collected. The pathogens and drug resistance were analyzed by SPSS 18.0 software. Results In this study, 109 cases were included, and 117 strains of the pathogens were isolated, including 53 isolates (45.3%) of gram negative bacteria, 41 isolates (35.0%) of gram positive bacteria, and 23 isolates (19.7%) of fungi. Escherichia coli (16/117, 13.7%), Enterococcus faecium (13/117, 11.1%), Candida parapsilosis (12/117, 10.3%), Klebsiella pneumoniae (9/117, 7.7%) and Enterococcus faecalis (8/117, 6.8%) were the top 5 species. Strains producing extended-spectrum beta-lactamase accounted for 87.5% of E. coli (14/16) and 44.4% (4/9) of K. pneumoniae isolates. Both E. faecium and E. faecalis were susceptible to vancomycin. C. parapsilosis showed the susceptibility to the antifungal agents. Conclusion Gram negative bacteria are predominant pathogens causing bloodstream infection after general surgery in infant and young children patients, and infection caused by resistant isolates should be prevented and controlled.
ObjectiveTo explore the prognostic risk factors of bloodstream infections caused by Acinetobacter baumannii in the hospital, to provide a basis for clinical diagnosis and treatment.MethodsA retrospective analysis was performed on the medical records of patients diagnosed with Acinetobacter baumannii bloodstream infection in Guangxi Zhuang Autonomous Region People’s Hospital between January 2013 and December 2018. The patients were divided into survival group and non-survival group according to the outcome within 30 days after blood culture was collected. Univariate and multivariate logistic analyses were used to identify the risk factors of Acinetobacter baumannii bloodstream infections.ResultsA total of 123 patients were included, including 48 in the survival group and 75 in the non-survival group. Third generation cephalosporins [odds ratio (OR)=2.492, 95% confidence interval (CI) (2.125, 2.924), P<0.001], carbapenems [OR=1.721, 95%CI (1.505, 1.969), P<0.001], multidrug resistant-Acinetobacter baumannii infection [OR=1.240, 95%CI (1.063, 1.446), P=0.006], post-operation [OR=0.515, 95%CI (0.449, 0.590), P<0.001], mechanical ventilation [OR=1.182, 95%CI (1.005, 1.388), P=0.043], indwelling central venous catheter [OR=0.116, 95%CI (0.080, 0.169), P<0.001], mixed infection or septic shock [OR=3.935, 95%CI (2.740, 5.650), P<0.001], APACHE Ⅱ score (≥15) [OR=5.939, 95%CI (5.029, 7.013), P<0.001], chronic kidney disease [OR=1.440, 95%CI (1.247, 1.662), P<0.001], immune system disease [OR=28.620, 95%CI (17.087, 47.937), P<0.001], use of corticosteroids [OR=0.520, 95%CI (0.427, 0.635), P<0.001], and combined antifungal agents [OR=0.814, 95%CI (0.668, 0.992), P=0.041] were independent factors for predicting the prognosis of patients with bloodstream infections caused by Acinetobacter baumannii.ConclusionsThe third generation cephalosporins, carbapenem, MDR-Acinetobacter baumannii infection, post-operation, mechanical ventilation, indwelling central venous catheter, mixed infection or septic shock, APACHE Ⅱ score (≥15), chronic kidney disease, immune system disease, use of corticosteroids, and combined antifungal agents were independent factors for predicting the prognosis of patients with bloodstream infections caused by Acinetobacter baumannii. In the clinical work, it is needed to carry out timely detection of microbial etiology, timely report, and reasonable treatment.